Should I ask for ELCS?

[wetnoodle]

First time mum and poster here!

I'm currently 21 weeks pregnant and I have an appointment with the consultant next week to discuss my childbirth options.

I've been researching all my options (was pretty set on a VBAC) but I've recently started to think I should request an ELCS. Reason being:

1. I'm currently on a daily dose of Clexane which means if I take it and labor within 12 hours I won't be able to have an epidural. Not sure I could cope with that because...

1. DS has a HUGE head. At my 20 week scan the sonographer was actually quite shocked when she measured it. He's way above average in regards to head size (off the scale, in fact). He obviously takes after DH, although I don't have the smallest head either

1. I'm 99% sure I would never consent to instrumental delivery plus I am TERRIFIED of tearing/episiotomy

My biggest fear is a long and painful labor without any pain relief that ends up with an EMCS or a horrific tear.

Thanks for your help!

Hi there,

You will probably find plenty of reassurance on here that you will be able to deliver naturally. I'm sure that there will also be plenty of people who understand if you want a c-section.

Ultimately, it's only you who can decide what you'd rather do. Is this your first pregnancy? It's just you mention VBAC (vaginal birth after caesarean) so obviously if you've had a previous c-section then that might influence how you feel about another one.

I've not heard of the drug that you're on so don't know much about it. Can you not have an epidural within 12 hours of the medication? My labour was well over 24 hours and I didn't have my epidural til about 15 hours into it, so could it be that if you do have a long labour that does give you enough time?

There are other pain relief options you could look at - pethidine/meptid, or water, hypnobirthing.

If I were in your shoes I'd be making an appt to discuss my fears with a consultant who would really be in the best position to advise you with regards to head size, pain relief etc etc.

Sorry, just seen you already have a consultant appt!

My bad re: VBAC, I'm a first time mum so I must mean vaginal birth. Not all the way clued up on the lingo.

Clexane is a blood thinner. Had a previous DVT and so I have to take it throughout pregnancy as a preventative measure. As it's a blood thinner you aren't able to have an epidural because of an increased risk of bleeding into the spine

Ah ok I was just trying to clarify you hadn't already had a section so I didn't go down the 'what was the reason for you previous section?' route.

Hmmm....I don't think anyone can tell you what to go for, but I understand your concerns and if I were in your position then I would probably be considering an ELCS. But really nobody but you can decide wht you want.

A good site to look at is csections.org which takes you through the risks associated with both c-sections and vaginal births.

Thanks! I'll have a look at that site.

I know it takes some time to heal after a CS but DH will be home for 2 weeks post birth and then my mom is coming over from the US for 2 weeks so I'll have someone around to help me/LO for about 4 weeks. Also MIL is retired, a real sweetheart and lives close by

Ok, good luck.

Bear in mind that if you do decide that an ELCS is right for you you may have a fight getting one on the NHS.

I have no idea what your consultants opinion will be regarding head size but I think it's unlikely they would agree to one just on the basis that you might not be able to have an epidural (no one is guaranteed an epidural as it's dependent on the anaesthetists availability).

If your consultant isn't supportive you can ask to see another one who may be more so.

Why would you not consent to an instrumental? A caesarean is far riskier for you and the baby if done at a late stage of labour, you are also much more likely to have a dvt yourself if you have a major operation.

Ultrasound scanning gives an idea of measurements but it is not 100% accurate and the baby may well grow at a slightly different rate, with its head growth evening out so to speak. Also the position that the head is in at the time of birth is far more important with regards to how easily it comes out than the size of head. You could always wait until much nearer the time to decide, if it is in the perfect position go for it, if not request a cs.

Most people who deliver vaginally don't have horrific tears, many have no stitches or a second degree tear, which may sound bad, but it is in fact what many women have stitched, and what for the vast majority heals well.

An elective cs may well be a fairly safe option, however with each subsequent caesarean section the risks increase greatly. If you plan to have more children, especially if you hope to have more than two, then it is important to take that in to account.

Good luck with your decision

I definitely think that I'll lead with the head issue as that's my main concern. The sonographer just seemed so shocked by the size that it's got me a bit worried.

I'm still coming to terms with the idea of pushing this kid out, so knowing he's got a ginormous head isn't helping to allay my fears.

I agree with Maxbear - the size of the family you want is a huge consideration. One c-s is a very safe operation, but the issues increase the more you have.

Perhaps I should raise my initial concerns with the consultant but, as Maxbear suggests, wait until nearer the time to discuss an ELCS. That will give me more time to weigh up the pros and cons as well as consider other pain management options (e.g. water birth)

Hey wetnoodle

I did a 19 hour labour with no epidural and decided to try a birth pool to see if it would help. Was miraculous. I am a huge wuss and yet I only needed gas and air for the final three cms. I am so proud of my labour experience, it really was one of the best days of my life, and it was only because of it that I coped when I had to have a c-section after my DS cleverly got into an unbirthable position.
I was so out of it during the section I barely remember my son being born. I then haemmorhaged and ended up in high dependency as my first night as a mum. They sent my partner home, so no one dressed DS and I have no idea if he cried for food or cold that night as I was so out of it. I'm not sure I'll ever get over that guilt. I would do my labour again like a shot, but I'll do anything not to have a section again.
Think of it this way, if you labour your baby is prepared for birth, his wee sugar stores are packed away ready to be used for his journey into the outside world, he's ready to breathe and feed. I'd say go for it. If it goes tits up at the end well you've had your section. If it doesn't, well you've avoided all the risks of major abdominal surgery and you'll not have to worry about future birth issues and VBACs where medics can seriously wade in and try to impose limits on how you labour in future. Ie no water birth, no induction, no home birth all sorts. I hope you find a route that works best for you. Good luck.

Sorry to hear of your experience poppet.

I have to disagree with you though that a vaginal birth necessarily = no worries about future birth issues.

All vaginal births are not equal, and I know of many women who've experienced ongoing issues as a result of vaginal births. And the same goes for c-sections really, your terrible c-s experience vs some very positive c-s expereiences.

It's really not cut and dried.

Hi Poppet, thanks for sharing your experience. I do like to idea of water birth but don't know much about it, yet.

If it came down to it, does anyone know if I'd be able to refuse instrumental delivery and opt for an emergency CS or would they attempt instrumental first no matter what?

I really don't like the idea of forceps or that plunger looking thing (ventouse?). I've read that instrumental deliveries can damage the pelvic floor and bladder not to mention some pretty serious side effects for the baby .

YOu can request no instruments in your birth plan but if the baby is down past a certain point in the birth canal then an instrumental delivery is normally safer than an EMCS.

This is one of the reasons I'm having an ELCS this time round, having suffered problems as a result of a previous instrumental delivery.

Withorwithoutyou - would you say my concerns re: instrumental birth are pretty valid then?

Honestly wetnoodle, I can't give you an unbiased answer.

I know a few people in RL who have had forceps deliveries and found them ok, not had any problems. I also know three people in RL (including me), who have had or have planned ELCS after forceps deliveries as a result of our experiences.

Instrumental delivery can be fine, or not fine. I do get very frustrated with the repeated mantra that vaginal birth is always better than c-section.

Just to chuck another viewpoint into the mix - I had an ELCS for my first child and found it calm, unscary and very straightforward - a really good experience - and DD and I did very well. I wasn't keen on an instrumental delivery either (my sister had a bad forceps experience). However, I was a private patient, and I think it can be a struggle to get an elective on the NHS. It varies from trust to trust, but I don't think they will give you one for the child having a larger than average head, for instance. However, if your fear of an instrumental delivery is at a phobic level, I suppose it might. However, elective sections can sometimes evoke a strong reaction on here, just to warn you. I would say do as much research into all kinds of births as you can. Good luck.